CROI 2015: As the impact and efficiency of medical circumcision increase, a target is lacking for a proven intervention

Science Speaks covered the 2015 Conference on Retroviruses and Opportunistic Infections in Seattle Washington from February 23-26, breaking news on HIV research findings and implications. On Thursday, one of the final conference sessions looked at challenges to measures proven to be effective. Today, Science Speaks recaps the first presentation, on circumcision.

SEATTLE, WA – What if the protection from HIV offered by medical circumcision came in a pill? How differently would we think of it?

Taken once, it would reduce an individual’s risks of becoming infected with HIV by 60-to70 percent for life. For every nine men to take that pill, one new infection, along with an average of 25 years of care and treatment for the virus, would be averted. With 80 percent coverage of the intervention, that adds up to 85 million person years of treatment — the number of people not infected, by the number of years they won’t need treatment — averted.

The question, and the data were part of a talk given by Anne Thomas of the U.S. Department of Defense and co-chair of a President’s Emergency Plan for AIDS Relief group working to scale up the intervention. Thomas, presenting the talk on behalf of Jason Reed of the Office of the U.S. Global AIDS Coordinator, concluded that although circumcision is not a pill, “We need a fourth ’90’.”

The reference was to UNAID’s proposed goal of three “90s” to reduce transmission of HIV and control the epidemic: a minimum of 90 percent of people with HIV being diagnosed, 90 percent of those diagnosed receiving antiretroviral treatment, and treatment suppressing the viruses of at least 90 percent of those receiving it.

After data showing the impact of circumcision in lowering transmission rates emerged in the last decade, Thomas noted, strong funding and ambitious target-setting had led to about 6 million medical circumcisions as part of HIV prevention measures by 2013, an estimated 9 million by 2014, and a projected 10 million by 2015. At the same time, she added, “We’ve only managed to reach the easy clients thus far.”

Work to increase demand for the procedure is promising, she said. But successes throughout PEPFAR’s responses has shown that setting targets is essential, she said. The target for 4.7 million circumcisions set by the White House in late 2011 led to doubled funding, and rollout of the intervention, she said. But once the target was reached, no new target was set. And now, she added, funding for circumcision is back to 2012 levels.